title: Temporal and multiinstitutional quality assessment of CT colonography.
abstract: OBJECTIVE
  The purpose of this study was to investigate the variability of CT colonography (CTC) scan quality obtained within and between institutions by using previously validated automated quality assessment (QA) software that assesses colonic distention and surface area obscured by residual fluid.
  
  
  METHODS
  The CTC scans of 120 patients were retrospectively selected, 30 from each of four institutions. The bowel preparation included oral contrast material for fecal and fluid tagging. Patients at one institution (institution 4) drank half the amount of oral contrast material compared with the patients at the other three institutions. Fifteen of the CTC scans were from the beginning of the protocol studied at each institution and 15 scans were from the same protocol acquired approximately 1 year later in the study. We used previously validated QA software to automatically measure the mean distention and residual fluid of each of five colonic segments (ascending, transverse, descending, sigmoid, and rectum). Adequate distention was defined as a colonic diameter of at least 2 cm. Residual fluid was determined by the percentage of colonic surface area covered by fluid. We compared how the quality varied across multiple institutions and over time within the same institution.
  
  
  RESULTS
  No significant difference in the amount of colonic distention among the four institutions was found (p = 0.19). However, the distention in the prone position was significantly greater than the distention in the supine position (p < 0.001). Patients at institution 4 had about half the amount of residual colonic fluid compared with patients at the other three institutions (p < 0.01). The sigmoid and descending colons were the least distended segments, and the transverse and descending colons contained the most fluid on the prone and supine scans, respectively. More recently acquired studies had greater distention and less residual fluid, but the differences were not statistically significant (p = 0.30 and p = 0.96, respectively).
  
  
  CONCLUSIONS
  Across institutions, a significant difference can exist in bowel preparation quality for CTC. This study reaffirms the need for standardized bowel preparation and quality monitoring of CTC examinations to reduce poor CTC performance.
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bldg. 10, Rm. 1C368X MSC 1182, Bethesda, MD 20892-1182, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Van Uitert
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Summers
authors.forename: Jacob M
authors.initials: JM
authors.lastname: White
authors.forename: Keshav K
authors.initials: KK
authors.lastname: Deshpande
authors.forename: J Richard
authors.initials: JR
authors.lastname: Choi
authors.forename: Perry J
authors.initials: PJ
authors.lastname: Pickhardt
mesh_terms: D000368:Aged; D015331:Cohort Studies; D023881:Colonography, Computed Tomographic / Q000379:methods* / Q000592:standards*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States